II. Pathophysiology
- Air continues to accumulate in pleural space, but cannot escape
III. Symptoms
- Sudden sharp Chest Pain
- Air Hunger
IV. Signs
- Unilateral absent breath sounds
- Hyperresonant chest to percussion
- Cyanosis
- Respiratory distress
- Tachycardia
- Hypotension
- Tracheal deviation to contralateral side
- Neck vein distention
V. Imaging
- Bedside Ultrasound
-
Chest XRay
- Do not use XRay to diagnose a Tension Pneumothorax
- Confirm diagnosis by Chest XRay after decompression
VI. Differential Diagnosis
VII. Precautions
- Tension Pneumothorax is a clinical diagnosis (not an imaging diagnosis)
- Do not obtain a Chest XRay prior to needle decompression (delays are lethal)
- Needle decompression buys a small amount of time in which to place a Chest Tube for definitive management
VIII. Management
- Emergent Needle Thoracentesis
- Do not wait for Chest XRay
- Use 14 gauge (5 cm long) angiocatheter in children and 10 gauge (7.5 cm long) angiocatheter in adults
- Insert angiocatheter over the top of the third rib in the mid-clavicular line
-
Chest Tube
- Perform immediately after needle decompression
- Insert over the top of the 5th rib in the mid-axillary line
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| MSH | D011030 |
| SnomedCT | 155611004, 233645004, 76537003 |
| Dutch | spanningspneumothorax |
| French | Pneumothorax sous tension |
| German | Spannungspneumothorax |
| Italian | Pneumotorace a valvola |
| Portuguese | Pneumotórax de tensão |
| Spanish | Neumotórax a tensión, neumotórax a tensión (trastorno), neumotórax a tensión |
| Japanese | 緊張性気胸, ｷﾝﾁｮｳｾｲｷｷｮｳ |
| English | tension pneumothorax (diagnosis), tension pneumothorax, pneumothorax tension, Pneumothoraxs, Tension, Pressure Pneumothoraxs, Pressure Pneumothorax, Pneumothorax, Tension, Pneumothoraxs, Pressure, Tension Pneumothorax, Tension Pneumothoraxs, Pneumothorax, Pressure, Tension pneumothorax, Tension pneumothorax (disorder) |
| Czech | Tenzní pneumotorax |
| Hungarian | Tensiós pneumothorax |
